Exploring Factors Associated With Long-Term Opioid Therapy in Cancer Survivors: An Integrative Review

Katie Fitzgerald Jones, Mei R. Fu, Jessica S. Merlin, Judith A. Paice, Rachelle Bernacki, Christopher Lee, Lisa J. Wood

Research output: Contribution to journalReview articlepeer-review


Context: The prevalence of chronic pain in cancer survivors is double that of the general U.S. population. Opioids have been the foundation of cancer pain management for decades; however, there is a paucity of literature on long-term opioid therapy (LTOT) in cancer survivors. An understanding of factors related to LTOT use in cancer survivors is needed to address chronic pain and balance opioid harms in the expanding population of cancer survivors. Objectives: To analyze the research of LTOT utilization and factors associated with persistent opioid use in cancer survivors. Methods: A five-stage integrative review process was adapted from Whittemore and Knafl. Data sources searched included Web of Science, PubMed, Embase, Cochrane, and Google Scholar. Quantitative research studies from 2010 to present related to cancer survivors managed on LTOT were included. Editorials, reviews, or abstracts were excluded. Results: After reviewing 315 articles, 21 articles were included. We found that there were several definitions of LTOT in the reviewed studies, but the duration of opioid use (i.e., more than three months after completion of curative treatment) was the most common. The reviewed literature describes a relationship between LTOT and important biopsychosocial factors (cancer type, socioeconomic factors, and comorbidities). Conclusion: The studies in this review shed light on the factors associated with LTOT in cancer survivors. LTOT was common in certain populations of cancer survivors and those with a collection of patient-specific characteristics. This review suggests that there is a critical need for specialized research on chronic cancer pain and opioid safety in cancer survivors.

Original languageEnglish (US)
Pages (from-to)395-415
Number of pages21
JournalJournal of Pain and Symptom Management
Issue number2
StatePublished - Feb 2021


  • Opioids
  • cancer survivors
  • chronic cancer pain
  • long-term opioid therapy
  • persistent opioid use

ASJC Scopus subject areas

  • General Nursing
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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